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Based on observation, review of critical access hospital (CAH) policy, review of professional literature, patient interview, and staff interview, the CAH failed to develop pest control policies and provide staff education for infection control standards regarding live bats in the facility, for 1 of 1 patient care unit. Failure to have standards and failure to provide education to staff regarding potential infectious risks of bats and bat droppings placed the CAH patients, staff, and visitors at risk of potential illness related to the bats.

Findings include:

Review of the CAH policy titled "Hospital Wide Infection Control Program" occurred on 07/23/13. This undated policy, stated, " The intent of this program . . . provide a safe comfortable environment for the patient/resident . . . INFECTION CONTROL COMMITTEE: Primary purpose is to establish the standards necessary to promote an adequate environment for the operation of the patient/resident care program. . . . Ensure . . . inservice training programs are provided to employees on a timely basis. . . EMPLOYEE EDUCATION: . . . continuing education as appropriate through out the year . . . COMMUNICATION . . . periodic staff meetings are held in which infection control issues may be discussed and recommendations made. . . . The nursing staff/infection control nurse collaborate with clinical and non-clinical areas to facilitate smooth seamless patient/resident flow of information in the effort to provide a continuum care. . . "

Review of Centers for Disease Control and Prevention website www.cdc.gov/Features/Bats occurred on 07/23/13. This article titled, "Take Caution When Bats Are Near" stated, " . . . Diseases Spread by Bats: Several highly fatal diseases have been linked to bats. Rabies is perhaps the most well known disease associated with bats. . . . Histoplasmosis [lung disease] is another disease associated with bats. . . . Stay Alert in Areas where Bats are Found: . . . It is also important to avoid being near or coming into contact with bat droppings. . . ."

During the entrance conference, on 07/23/13 at 8:05 a.m., an administrative staff member (#5) reported the following:
- The CAH identified a problem with bats in the ceiling of the second and third floors of the building on 07/10/13.
- The CAH contacted its pest control provider on 07/11/13. The provider told the CAH bats are a "protected" species; could only be caught and released; and, recommended closing entry portals to the CAH and trapping the bats.
- The CAH closed the entry vents on 07/12/13.
- CAH staff have caught and released bats.
- The number and frequency of bats caught is declining, indicating a decline in the numbers of bats.
- No patients have had contact with bats.

During interviews on 07/23/13, CAH staff members reported the following:
- 7:45 a.m., a nursing staff member (#1) - she heard noises in the ceiling attributed to bats. Other staff have reported seeing bats. She did not see bats.
- 7:55 a.m., a nursing staff member (#2) - she heard noises in the ceiling attributed to bats. Staff member (#2) reported she did see a bat on July 20 in the patient dining room before patients came in for breakfast. She reported staff caught the bat on the floor with an empty waste basket and released it outdoors. She did not see the bat on any other surface or in any other area. Staff member (#2) was uncertain if the CAH staff cleaned the floor area where staff caught the bat.
- 8:35 a.m., a housekeeping staff member (#3) - she stated she "heard of bats on the third floor [long-term care]," but none in the CAH.
- 8:45 a.m., a nursing staff member (#4) - she stated she heard of bats in the CAH, but did not see any.

The above staff members reported the CAH did not provide instructions regarding handling of bats or potential infection control issues for residents, staff, or visitors related to bats or bat droppings.

The CAH identified Patient #1 was interviewable. During interview, on 07/23/13 at 7:05 a.m., Patient #1 reported no problems regarding pests and denied seeing any flying insects or pests.

The CAH identified Patient #2 was interviewable. During interview, on 07/23/13 at 7:15 a.m., Patient #2 reported he had not seen any insects or pests.

During interview, on 07/23/13 at 9:30 a.m., an administrative nursing staff member (#6) reported the CAH discussed handling of bats during a staff meeting on 07/18/13. Review of the CAH nursing staff meeting notes from 07/18/13 occurred on 07/23/13. The notes did not include information on bats or education related to infection control issues regarding bats and potential infections and harm to residents, staff, or visitors.

During an interview on 07/23/13 at 8:55 a.m., a housekeeping supervisor (#7) reported the housekeeping staff sanitized the areas after staff caught a bat. The staff member reported she provided education on a one-to-one basis to some of the housekeeping staff regarding observing for droppings and sanitizing after staff caught bats. The staff member reported she did not have documentation of the education provided. The CAH failed to develop policies/procedures or provide education to all the housekeeping staff. The staff member reported she was not aware of any education provided to any CAH staff members regarding infection control issues related to bat infestation.

During an interview on 07/23/13 at 10:00 a.m., a maintenance supervisor (#9) confirmed the information provided by the CAH's administrative staff during the entrance conference at 8:05 a.m. Review of the combined facility (CAH and long-term care) maintenance requests showed the long-term care staff identified a noise in the ceiling above the long-term care nurse's station the evening of 07/08/13 and investigated it on 07/10/13. This staff member reported he did not provide education to maintenance staff regarding infection control precautions for handling bats and was not aware of any other education provided.